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Ergospirometry

Ergospirometry

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Published by: Nikos on Sep 27, 2008
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Oxycon MobileOxycon MobileOxycon MobileOxycon MobileOxycon Mobile
A milestone in CPET
Oxycon POxycon POxycon POxycon POxycon Prororororo
CPET of the highest quality
1st edition, April 20021st edition, April 20021st edition, April 20021st edition, April 20021st edition, April 2002
CPETCPETCPETCPETCPET
Various fields of application
Special Edition:Cardiopulmonary Exercise Testing
Information, Diagnostics, Essays
Vmax und CardiosoftVmax und CardiosoftVmax und CardiosoftVmax und CardiosoftVmax und Cardiosoft
CPET made by SensorMedics,ECG made by Marquette Hellige
 
2
VIASYS info Special Edition CPET, April 2002
EditorialTable of Contents
 Paul ter Grote 
Managing Director of Erich JAEGER GmbH,a subsidiary of VIASYS Healthcare 
Dear readers,It has always been the wish of mankind to go to the limits of our capacities. Even the ancient Greeks used to send messagesthrough couriers who were able to run hundreds of miles in acouple of days. If the first marathon runner in history had hadour knowledge and had been trained according to current stan-dards, he would not have collapsed of exhaustion after having been informed of the first Athenian victory over the Persiantroops in 490 b.c. However, despite our medical findings, car-diopulmonary exercise testing is still a fascinating subject for  physicians and researchers of various medical fields.This first special VIASYS info edition is especially aimed atclinicians who wish to be informed about reasons, indicationsand interpretation of cardiopulmonary exercise testing and whoare interested in their collegues' research findings.Apart from its application in athletic performance, cardiopul-monary exercise testing can be used in various medical fields(an overview of which is provided on page 8). Until now, exer-cise testing has only been practiced by experts. Today we seean increasing interest from healthcare providers. We hope toinform you with interesting literature suitable to support youin your daily work. If you are interested in learning more aboutcardiopulmonary exercise testing - please read through our bro-chure or simply refer to the literature references on page 31.Sincerely Yours,
Essay
Exercise Testing: The "How" and the "Why"Author: Prof. Brian J. Whipp Ph.D., D.Sc...............................3
Fields of Application
CPET - Various Fields of ApplicationIndications and relevance of CPET..........................................8
Diagnostics
Oxycon ProCPET of the Highest Quality..................................................10
Practical Guidelines
CPET- Practical GuidelineAuthor: Wolfgang Mitlehner, M.D.........................................12
Diagnostics
Vmax and CardiosoftCPET made by SensorMedics,ECG made by Marquette Hellige...........................................20Oxycon Mobile.......................................................................23
Essay
Clinical Relevance of CPETAuthor: Prof. Karl-Heinz R¸hle, M.D...................................24
Essay
Evaluation and Interpretationof a cardiopulmonary exercise testAuthor: Hermann Eschenbacher, Ph.D..................................26
The Last Page
Literature references, Training courses, seminars..................31
CPETCPETCPETCPETCPET
History, approaches and applications
 
3
VIASYS info Special Edition CPET, April 2002
2.2.2.2.2.IntrIntrIntrIntrIntroductionoductionoductionoductionoduction
The tolerable range of work rates in patients with lung disease is constrained by a com- bination of factors, chief of which are:a)impaired pulmonary-mechanical and gas exchange function which increases the de-mand for airflow and ventilation; b)limitations in response capabilities, either of airflow generation or of lung distensi-on;c)increased physiological costs of meeting the ventilatory responses, in terms of respi-ratory muscle work, blood flow and O
2
consumption;d)predisposition to 'shortness of breath' or 'dyspnoea' as a consequence of the highfraction of the achievable ventilation demanded by the work rate, commonly exacer- bated by arterial hypoxaemia; ande)the often-marked reduction in the range of spontaneously-selected daily activities,which results from the dyspnoea, and further reduces the state of physical training.
 Brian J. Whipp, Ph.D., D.Sc.Centre for Exercise Science and Medicine, University of Glasgow,Glasgow, UK 
Essay
1.1.1.1.1.AimsAimsAimsAimsAims
To address the role of exercise testing in elucidating the causes of exercise intolerance,with particular reference to pulmonary disease.To discuss the value of clinical exercise testing, in:a)establishing the limits of system function b)defining the effective operating rangec)identifying potential causes of exercise intoleranced)evaluating the normalcy of the response with regard to a reference populatione)establishing the normalcy of response with regard to other physiologicalfunctionsf)providing a frame of reference for change with respect to therapeuticinterventions or training, andg)as a means of "triggering" an abnormality.To emphasise the importance of domains of exercise intensity and identifying thedeterminants of an "appropriate" ventilatory response, including considerations of:a)to what extent are the "requirements" met? b)what is the "cost" of meeting these requirements?c)to what extent is the system "constrained" or "limited"? andd)how "intensely" is the response perceived?To establish the physiological basis of the profiles of cardiopulmonary system responsesto incremental exercise performed to the limit of tolerance.To recognise when the value of a particular variable or its response profile reflects anabnormality of system(s) functioning, both with respect to(a)the work rate itself or to other related variables and(b)consideration of responses that are often misrepresented as reflecting systems behaviour.
Exercise TExercise TExercise TExercise TExercise Testing: The "How" and the "Why"esting: The "How" and the "Why"esting: The "How" and the "Why"esting: The "How" and the "Why"esting: The "How" and the "Why"
Strategies designed to increase exercisetolerance in such patients should thereforeattempt both to increase (where possible) theventilatory limits, reduce the demand for ventilation and reduce the intensity of, or attempt to desensitize the subject to, theconsequent dyspnoea.In order to meet the increased demands for  pulmonary gas exchange during exercise, thelungs must replenish the O
2
extracted fromthe alveoli by the increased flow of moredesaturated mixed venous blood. This preserves alveolar, and hence arterial, O
2
 partial pressure. The lungs must also provideto the alveoli diluting quantities of CO
2
-free(atmospheric) air at rates commensurate withthe increased delivery rate of CO
2
in themixed venous blood. This maintains alveolar,and hence arterial, PCO
2
. However, themetabolic (chiefly lactic) acidosis of high-intensity exercise requires that alveolar andarterial PCO
2
be reduced to provide acomponent of respiratory compensationwhich constrains the fall of arterial pH.The pulmonary system is therefore confron-ted by different demands for blood-gas andacid-base regulation during exercise. Thereare competing ventilatory demands for alve-olar PO
2
and PCO
2
regulation when the re-spiratory exchange ratio differs from unity,and also for arterial PCO
2
and pH regulationwhen the exercise results in a metabolic aci-dosis. In patients with lung disease, this pro-cess is further complicated by pulmonary gasexchange inefficiencies which result in of-ten-marked differences between alveolar (either ëidealí or ërealí) and arterial gas par-tial pressures. Consequently, the impaired pulmonary gas exchange in patients withchronic lung disease further increases theventilatory demand during exercise; the im- paired pulmonary mechanics, however, cons-trains or even limits the ability to meet thedemands.

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